Surgical Oncology[JOURNAL]
Sun
200 papers
Institutional Learning Curve in Esophagectomy: Technical Standardization of Gastric Conduit Formation and Conduit-Related Outcomes in 187 Consecutive Patients.
Tripathi M, Balachandran RR, Vineet K … +4 more , Vadodaria D, Kushwaha V, Ansari MI, Shukla P
J Surg Oncol · 2026 Jul · PMID 42402157 · Publisher ↗
BACKGROUND: Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team-b...
BACKGROUND: Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team-based decision-making. Gastric conduit viability remains central to safe esophageal reconstruction, with conduit ischemia, torsion, and tension contributing substantially to leak and necrosis. We examined the institutional learning curve of a high-volume esophageal cancer program, focusing on technical standardization of gastric conduit formation and conduit-related outcomes. METHODS: We retrospectively analyzed 187 consecutive patients who underwent esophagectomy for locally advanced esophageal cancer between 2019 and 2025 at a tertiary cancer center. For descriptive temporal comparisons, the cohort was divided into two pragmatic phases corresponding to institutional practice before and after routine formalization of the conduit protocol: up to 2022 (n = 101) and 2023-2025 (n = 86). During program maturation, a standardized gastric conduit protocol was formalized, emphasizing preservation of conduit vascularity, controlled conduit geometry, minimal omental bulk, cervical-first dissection, torsion-free transposition, and selective pyloric management. The primary outcome was composite major conduit-related morbidity, defined per patient as major anastomotic leak, major conduit necrosis, or conduit-related re-exploration. Secondary outcomes included overall leak, vocal cord palsy, chyle leak, Clavien-Dindo grade, 30-day mortality, R0 resection, and lymph node yield. Outcomes were interpreted within the broader context of institutional maturation rather than as a simple calendar-era comparison. RESULTS: Composite major conduit-related morbidity declined from 8.9% in the earlier phase of the program to 2.3% in the later phase. Within this composite, major conduit necrosis declined from 5% to 0%, while overall leak rates remained stable. Thirty-day mortality was 4.3%, and most complications were minor. Oncologic adequacy was preserved, with R0 resection in 94.7% and a median lymph node yield of 25. Improvements in pathological complete response and recurrence over time paralleled broader changes in neoadjuvant treatment intensity and lymphadenectomy and should not be attributed solely to conduit protocolization. CONCLUSIONS: Institutional maturation in esophagectomy was associated with transition from experience-dependent practice to reproducible technical standardization of gastric conduit formation. This learning curve coincided with disappearance of major conduit necrosis without compromising oncologic adequacy. Standardization of conduit construction may represent an important and exportable quality-improvement step in developing high-volume esophageal cancer programs, especially in resource-variable settings.
Evaluating the Accuracy of ChatGPT-4o in Addressing Complex Clinical Questions Based on NCCN Guidelines for Rectal Adenocarcinoma.
Meyer R, Bresler TE, Palmer KM … +3 more , Wilson T, Pandya S, Fujita M
J Surg Oncol · 2026 Jul · PMID 42402154 · Publisher ↗
INTRODUCTION: The management of rectal adenocarcinoma requires navigation of complex, branching guideline pathways encompassing neoadjuvant sequencing, surgical approach, organ preservation, and surveillance, yet real-wo...
INTRODUCTION: The management of rectal adenocarcinoma requires navigation of complex, branching guideline pathways encompassing neoadjuvant sequencing, surgical approach, organ preservation, and surveillance, yet real-world guideline adherence remains as low as 60-70%. The ability of current-generation large language models (LLMs) to accurately navigate these decision points has not been fully characterized. METHODS: In this cross-sectional, vignette-based study, 135 clinical questions were constructed from 45 pages of NCCN Rectal Cancer Guidelines (Version 4.2024). ChatGPT-4o was queried using standardized prompts with up to 3 clarifying questions permitted per query. Responses were independently evaluated by two physician raters on a 5-point Likert scale, with potential discrepancies adjudicated by a board-certified surgical oncologist. Primary outcomes were the proportion of responses rated Correct (score ≥ 3) and Accurate (score ≥ 4). Inter-rater reliability was assessed using Cohen's kappa, and subgroup analysis was performed across clinical domains using the Kruskal-Wallis test. RESULTS: Of 135 questions, 127 (94.1%; 95% CI, 88.7-97.0%) were Correct and 121 (89.6%; 95% CI, 83.3-93.7%) were Accurate. One hundred two responses (75.6%) were completely correct without additional prompting. Performance was consistent across clinical domains (Kruskal-Wallis H = 0.530, p = 0.767). Inter-rater agreement was perfect (κ = 1.0). Eight responses (5.9%) contained partially or wholly incorrect information, with errors concentrated in multi-step conditional treatment decision points. CONCLUSION: ChatGPT-4o demonstrates high concordance with NCCN rectal cancer guidelines across all evaluated clinical domains with notable improvement over prior ChatGPT iterations evaluated by our group. The concentration of errors in complex conditional treatment algorithms suggests that LLMs excel at discrete factual recall but may struggle with multi-step reasoning under clinical uncertainty. Prospective validation using real-world clinical data and comparison with multidisciplinary tumor board recommendations remain necessary prior to clinical integration.
Racial Differences in Breast Cancer Treatment and Information Access.
Williams T, Li MX, Fine KS … +7 more , Melnick BA, Ho KC, Joseph J, Allums J, Casas Fuentes RJ, Coles BM, Galiano RD
J Surg Oncol · 2026 Jul · PMID 42402153 · Publisher ↗
BACKGROUND AND OBJECTIVES: Persistent disparities in breast cancer (BC) care highlight the need to better understand patient experiences across diverse populations. This study examined racial differences in BC treatment,...
BACKGROUND AND OBJECTIVES: Persistent disparities in breast cancer (BC) care highlight the need to better understand patient experiences across diverse populations. This study examined racial differences in BC treatment, BR decisions, and social media use. METHODS: A web survey of 413 racially diverse breast cancer survivors collected self reported clinical data, BREAST-Q scores, and social media use. Multivariate regression examined BC treatment, BR complications, social media use, and satisfaction by race. RESULTS: Black and Hispanic women were more likely to have mastectomy and chemotherapy than white women (p < 0.01; p < 0.001), even after adjusting for stage (p = 0.368). Asian women were less likely to receive chemotherapy or radiation (p < 0.01). Despite more breast-conserving surgery (p < 0.001 vs. Black; p < 0.05 vs. Hispanic), white women reported lower breast satisfaction (p < 0.05). Black and Hispanic women relied more on social media for information (p < 0.001; p < 0.01). Younger age, tobacco use, radiation, and comorbidities increased BR complication risk. CONCLUSIONS: Women of color in this study experienced more aggressive treatment patterns and were more likely to rely on social media for information, highlighting an opportunity to address inequities in breast cancer care. Leveraging social media to deliver culturally tailored, evidence-based information may enhance understanding of treatment and surgical options, as well as complication risks, thereby promoting more equitable, patient-centered care.
Long-term quality of life after cytoreductive surgery and HIPEC: A survivorship analysis.
Madeira-Cardoso MJ, Peyroteo M, Guimarães A … +6 more , Pinto P, Marques M, Sousa A, Sousa F, Fernandes M, de Sousa JA
Surg Oncol · 2026 Jul · PMID 42401102 · Publisher ↗
BACKGROUND: Peritoneal Carcinomatosis (PC) has a negative impact on patients' physical and mental health, decreasing quality of life (QoL). Cytoreductive Surgery and HIPEC (CRS + HIPEC) is the only potentially curative o...
BACKGROUND: Peritoneal Carcinomatosis (PC) has a negative impact on patients' physical and mental health, decreasing quality of life (QoL). Cytoreductive Surgery and HIPEC (CRS + HIPEC) is the only potentially curative option for PC. However, it can be an aggressive procedure requiring multivisceral resection, particularly involving the gastrointestinal (GI) tract. Its impact on long-term QoL remains poorly established. OBJECTIVE: To evaluate the long-term impact of CRS + HIPEC on both generic and GI QoL in our Centre and to compare generic QoL results with standard values for the Portuguese Population (PtP). MATERIALS AND METHODS: A single-center retrospective analysis was performed including all patients who underwent CRS + HIPEC with curative intent between 2016 and 2020. All selected patients completed three QoL questionnaires: the SF-36, the Gastrointestinal QoL Index (GIQLI), and the EORTC QLQ-C30. RESULTS: Mean time between CRS + HIPEC and the QoL survey was 66 ± 19 months. The median SF-36 scores, evaluating generic QoL, were very high, and no differences were found when compared with standard values for the Portuguese population. Furthermore, patients who underwent CRS + HIPEC showed better QoL outcomes in Emotional Performance (EP), Mental Health (MH), Social Function (SF), and Pain (P) (p < 0.005). When evaluating GI-specific QoL, both the GIQLI and EORTC QLQ-C30 reflected few or no GI symptoms (GIQLI ≥3; EORTC QLQ-C30 0-33). When specifically analysing patients who underwent GI resection, some GI symptoms were more prevalent, although infrequent, with no significant differences between groups. CONCLUSION: CRS + HIPEC does not appear to have a significant long-term negative impact on either generic QoL or specific GI parameters.
Comparative Analysis of CEM and Breast MRI: A Retrospective Study.
Tomala J, Upadhyay N
J Surg Oncol · 2026 Jul · PMID 42394378 · Publisher ↗
INTRODUCTION: Breast cancer is a prevalent malignancy where accurate preoperative assessment is crucial for treatment planning. Breast MRI is a highly sensitive imaging modality for breast cancer detection. It is widely...
INTRODUCTION: Breast cancer is a prevalent malignancy where accurate preoperative assessment is crucial for treatment planning. Breast MRI is a highly sensitive imaging modality for breast cancer detection. It is widely used preoperatively and can assist with local staging, tumour size assessment, detection of additional tumour foci and assessment of treatment response in patients receiving neoadjuvant chemotherapy. Contrast-enhanced spectral mammography (CEM) is an emerging alternative with comparable diagnostic performance and shorter examination times. This study retrospectively compares CEM and MRI in measuring breast cancer extent. METHODS: In this retrospective study conducted at Imperial College Healthcare NHS Trust, 58 patients with histologically confirmed breast cancer who underwent both CEM and MRI between January 2020 and July 2023 were included. Lesion sizes were evaluated on both modalities and compared with the postoperative histopathology specimen using the Wilcoxon signed-rank test and Pearson correlation. RESULTS: There was no statistically significant difference in average tumour size between CEM and MRI (28.8 mm (SD = 22.8) on CEM and 31.8 mm (SD = 24.2) on MRI; p = 0.1058). Both imaging modalities demonstrated similar measurement precision when compared with the surgical specimen (12.9 mm vs. 12.2 mm absolute mean difference between histopathological and radiological measurement - MRI and CEM respectively). Pearson analysis demonstrated a good correlation with postoperative histopathology in size measurement, with CEM showing slightly stronger correlation (r = 0.7858, p < 0.0001, n = 45) compared with MRI (r = 0.6726, p < 0.0001, n = 46). DISCUSSION: CEM appears to be a viable alternative to MRI. This study demonstrates high sensitivity of CEM and MRI for breast cancer detection, with no statistically significant difference in maximum diameter of enhancing abnormalities. Both modalities strongly correlate with histopathology. Further studies are required to validate the role of CEM in clinical practice.
Comparative safety of postoperative HIPEC with recombinant mutant TNF-α versus paclitaxel for gastric cancer peritoneal metastasis: a randomized controlled trial.
Lu Z, Cai X, Yang C … +3 more , Xiang Z, Xiong B, Peng C
Surg Oncol · 2026 Jun · PMID 42391679 · Publisher ↗
BACKGROUND/OBJECTIVES: Peritoneal metastasis (PM) of gastric cancer (GC) is frequently resistant to systemic chemotherapy, which leads to a poor prognosis. This study was designed to compare the safety and tolerability o...
BACKGROUND/OBJECTIVES: Peritoneal metastasis (PM) of gastric cancer (GC) is frequently resistant to systemic chemotherapy, which leads to a poor prognosis. This study was designed to compare the safety and tolerability of hyperthermic intraperitoneal chemotherapy (HIPEC) with recombinant mutant human tumor necrosis factor-α (rmhTNF) versus paclitaxel after radical surgery for GC. METHODS: Patients with locally advanced or metastatic GC who underwent surgical exploration at the Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University were prospectively enrolled and randomly assigned to three groups. All patients received HIPEC on the 1st and 3rd postoperative day. The HIPEC regimens were as follows: rmhTNF (Group A), paclitaxel (Group B), and rmhTNF + paclitaxel (Group C). RESULTS: A total of 30 patients were enrolled in this study, with 10 patients each in groups A, B and C. There were no statistically significant differences in postoperative first activity, gastrointestinal function recovery, catheter removal, and length of hospital stay (P > 0.05). Postoperative complications, including abdominal distension, discomfort, anastomotic leakage, myelosuppression, infection, and fever, did not demonstrate statistically significant differences among the three groups (P > 0.05). Similarly, no statistically significant differences were observed in hematology, liver and kidney function, and postoperative coagulation function among the three groups of patients before surgery, after the first HIPEC treatment, before the second HIPEC treatment, and after the second HIPEC treatment (P > 0.05). After a median follow-up of 14 months, a total of 10 patients (34.5%) experienced recurrence. CONCLUSION: The safety and tolerability of rmhTNF for HIPEC in GC were confirmed. Additionally, rmhTNF did not impede gastrointestinal recovery or increase postoperative complication rates.
Early postoperative hospital exposome stress, multisystem recovery trajectories, and long-term oncologic outcomes after curative colorectal cancer surgery.
Pan S, Wang G
Surg Oncol · 2026 Jun · PMID 42391678 · Publisher ↗
BACKGROUND: Postoperative recovery after colorectal cancer surgery is highly heterogeneous and incompletely explained by tumor stage or operative factors. Whether early postoperative inpatient stress exposure and subsequ...
BACKGROUND: Postoperative recovery after colorectal cancer surgery is highly heterogeneous and incompletely explained by tumor stage or operative factors. Whether early postoperative inpatient stress exposure and subsequent multisystem recovery dynamics are associated with ctDNA-defined molecular residual disease and long-term oncologic outcomes remains unclear. METHODS: In this prospective longitudinal cohort study, 1200 patients undergoing curative-intent resection for stage II-III colorectal cancer (2018-2020) were followed for up to 60 months. Early postoperative hospital exposome stress was quantified using a prespecified composite Hospital Exposome Stress Load (HESL) assessed during postoperative days 0-7. HESL was conceptualized as a composite inpatient recovery exposure based on routinely captured proxy indicators, rather than as a direct physical measurement of the ward environment. To address potential reverse causation, environmental/nocturnal disruption components were distinguished from care-process or clinical-intensity components in sensitivity analyses. Multisystem recovery trajectories were derived from repeated physiological and inflammatory measures using latent class mixed modeling. Trajectory classification was based on standardized recovery scores at POD3 and POD7 and did not include postoperative length of stay or downstream oncologic outcomes. Outcomes included clinically significant postoperative complications, ctDNA-defined molecular residual disease (MRD), and disease-free survival (DFS). RESULTS: Higher HESL was associated with increased risk of postoperative complications and a greater likelihood of maladaptive recovery trajectories. MRD positivity increased stepwise across HESL tertiles (9.8%, 14.9%, and 22.4%, respectively), and both high HESL (adjusted OR 2.12, 95% CI 1.36-3.30) and maladaptive recovery phenotypes (adjusted OR 2.89, 95% CI 1.78-4.70) were associated with MRD positivity. Over long-term follow-up, elevated HESL (adjusted HR 1.68, 95% CI 1.32-2.14) and maladaptive recovery trajectories (adjusted HR 2.21, 95% CI 1.63-2.99) were associated with inferior DFS. Findings were robust across multiple sensitivity analyses. CONCLISIONS: Early postoperative hospital exposome stress and multisystem recovery trajectories were associated with molecular residual disease and long-term oncologic outcomes after curative colorectal cancer surgery. Because HESL included both environmental/nocturnal disruption proxies and care-process intensity indicators, these findings should be interpreted as prognostic and hypothesis-generating rather than causal.
Prognostic significance of age in adult primary intestinal diffuse large B-cell lymphoma: Insights from the SEER database.
Tsai HT, Lee CH, Chen HA
Surg Oncol · 2026 Jun · PMID 42385448 · Publisher ↗
BACKGROUND: Primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) is a rare subtype of non-Hodgkin lymphoma. We aimed to evaluate the prognostic significance of age in patients with PI-DLBCL. METHODS: The Surveilla...
BACKGROUND: Primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) is a rare subtype of non-Hodgkin lymphoma. We aimed to evaluate the prognostic significance of age in patients with PI-DLBCL. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database 2000-2021 was reviewed for patients ≥18 years old diagnosed with PI-DLBCL. Overall survival (OS) and cancer-specific survival (CSS) were the primary endpoints. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Patients were categorized as 18-59, 60-79, and ≥80 years old. RESULTS: A total of 4167 patients were included. Compared to the 18-59 age group, patients aged 60-79 had worse OS (aHR = 2.39, 95% CI: 2.11-2.70) and CSS (aHR = 1.83, 95% CI: 1.57-2.13), and those ≥80 years old had the worst survival (OS/CSS: aHR = 5.25/3.86; 95% CI: 4.56-6.03/3.26-4.58). Across all age groups, chemotherapy (OS aHR range: 0.39-0.63) and surgery (OS aHR range: 0.65-0.78) were significantly associated with reduced mortality. In the 18-59 year old group, B symptoms (OS/CSS aHR = 1.52/1.81) and being unmarried or divorced/widowed (CSS aHRs: 1.49-1.59) predicted worse outcomes. In the 60-79 year old group, male sex (OS/CSS aHR = 1.25/1.25) and Black race (CSS: aHR = 1.71) were significant risk factors. CONCLUSIONS: Age is a strong, independent predictor of survival in patients with PI-DLBCL. Younger patients had more diverse prognostic factors, while treatment status was the dominant determinant in older adults. These findings support age-specified treatment approaches for patients with PI-DLBCL.
The Treatment Efficacy for Patients Undergoing Combined Transanal-Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis.
Wan T, Shi Y, Zhou Y … +10 more , Zheng H, Xie H, Ye F, Huang P, Alenzi M, Liu Z, Cai Y, Luo S, Kang L, Huang L
J Surg Oncol · 2026 Jul · PMID 42385137 · Publisher ↗
BACKGROUND: Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate t...
BACKGROUND: Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate the therapeutic efficacy of combined transanal-transabdominal resection in patients with rectal anastomotic stenosis. METHODS: We retrospectively analyzed a consecutive cohort of patients who underwent combined transanal-transabdominal endoscopic resection for rectal anastomotic stenosis between August 2019 and March 2023. Data on intraoperative variables, mortality, postoperative complications, and stoma closure were collected. Functional outcomes were evaluated using the Low Anterior Resection Syndrome (LARS) score and the Wexner incontinence score. RESULTS: A total of 54 patients, including 46 men and 8 women, met the inclusion criteria. In all patients, anastomotic stenosis developed secondary to either anastomotic leakage or preoperative radiotherapy. The median length of hospital stay was 15 days (11-24 days). No postoperative mortality occurred, and the overall morbidity rate was 15%. During a median follow-up of 48 months, stoma closure was achieved in 49 patients after a median interval of 3.8 months (2.5-11 months). At the end of follow-up, stoma closure had failed in 2 patients because of poor anastomotic functional outcomes, and 3 patients developed recurrent anastomotic stenosis. Among the 49 patients available for functional assessment, 35 (71.4%) reported no or minor LARS. The median Wexner incontinence score was 8 (0-18), and 13 patients had a score of 0. Erectile function was evaluated in 28 male patients, of whom 18 reported normal postoperative erectile function. CONCLUSIONS: Combined transanal-transabdominal endoscopic resection appears to be an effective treatment for rectal anastomotic stenosis, with a high rate of stoma closure, low morbidity, and acceptable long-term functional outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NCT06036862.
"It Depends on the Situation": Variability in How Surgical Oncologists Elicit and Integrate Patient Values.
Speer JEF, Bechthold AC, Monton O … +3 more , Newcomb A, Odom JN, Kopecky KE
J Surg Oncol · 2026 Jul · PMID 42385133 · Publisher ↗
BACKGROUND: Understanding what matters most to patients is central to person-centered care, particularly in surgical oncology, where decisions often involve significant tradeoffs. We explored how surgeons elicit, integra...
BACKGROUND: Understanding what matters most to patients is central to person-centered care, particularly in surgical oncology, where decisions often involve significant tradeoffs. We explored how surgeons elicit, integrate, document, and support patient values in cancer-related decision-making. METHODS: This qualitative descriptive study involved semi-structured interviews with surgical oncologists (June-September 2025). Participants were purposively sampled from a prior international survey to ensure variation in demographics. Interviews were recorded, transcribed, and analyzed using thematic analysis. Participant characteristics were summarized descriptively. RESULTS: Fourteen surgeons participated. Most were male (71%), White (86%), and early-career (43%), practicing primarily in gastrointestinal or hepatobiliary surgery (each 43%) at academic centers (57%) in the U.S. South or Midwest (each 36%). Surgeons described various approaches to eliciting values, including inferring values from contextual clues and clarifying tradeoffs between survival and quality-of-life. Values elicitation was largely situational, occurring in high-risk or preference-sensitive contexts. When values conflicted with recommendations, surgeons adapted plans within oncologic safety. Documentation varied and was shaped by relevance, medicolegal concerns, and workflow. Barriers included time limitations, emotional distress, family dynamics, and limited training. CONCLUSIONS: Values elicitation was inconsistent and situational rather than routine. More structured, earlier approaches and system-level support may better align surgical decisions with patient values.
Total neoadjuvant therapy versus standard neoadjuvant chemoradiotherapy for locally advanced rectal cancer: A systematic review and meta-analysis of long-term outcomes.
Choi SJ, Chae G
Surg Oncol · 2026 Jun · PMID 42378863 · Publisher ↗
BACKGROUND: Total neoadjuvant therapy (TNT) is increasingly used for locally advanced rectal cancer (LARC), but most evidence is based on short- or intermediate-term follow-up. We evaluated whether TNT improves long-term...
BACKGROUND: Total neoadjuvant therapy (TNT) is increasingly used for locally advanced rectal cancer (LARC), but most evidence is based on short- or intermediate-term follow-up. We evaluated whether TNT improves long-term disease-free survival (DFS), overall survival (OS), pathological complete response (pCR), locoregional recurrence (LR), and distant metastasis (DM) compared with standard neoadjuvant chemoradiotherapy (nCRT). PATIENTS AND METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to March 2026 (PROSPERO CRD420261350004). Phase II/III randomized trials comparing TNT with nCRT in adults with MRI-confirmed LARC (cT3-4 and/or cN+, M0) and a minimum median follow-up of 5 years were included. Outcomes were pooled using DerSimonian-Laird random-effects models. RESULTS: Five trials including 2104 patients were analyzed (1063 TNT, 1041 nCRT; median follow-up 67-87 months). TNT improved DFS (HR 0.85, 95% CI 0.74-0.98; P = 0.025; I = 0%) and pCR (OR 1.99, 95% CI 1.45-2.73; P < 0.001; I = 30.6%), but did not improve OS (HR 0.89, 95% CI 0.76-1.05) or significantly reduce DM (OR 0.81, 95% CI 0.64-1.03). LR was not significantly different in the primary analysis (OR 1.24, 95% CI 0.95-1.62; P = 0.111). In a harmonized sensitivity analysis restricted to true pelvic recurrences after complete resection, LR showed a non-significant numerical increase with TNT (OR 1.38, 95% CI 0.98-1.95; P = 0.062). CONCLUSIONS: TNT nearly doubled pCR and modestly improved long-term DFS, but did not improve OS or significantly reduce DM. Although not statistically significant, a possible increase in true LR could not be excluded; this hypothesis-generating signal, together with the absence of an OS benefit, suggests that the long-term benefit of TNT may be more limited than short-term outcomes imply.
Associations of latent profiles of resilience and fear of progression with discharge symptoms and postoperative frailty among patients undergoing lung resection: A longitudinal study.
Ma F, Zhao L, Wang W … +8 more , Zhu Y, Ma J, Diao Y, Wang S, Xu Y, Kan J, Yan J, Zhang F
Surg Oncol · 2026 Jun · PMID 42372319 · Publisher ↗
BACKGROUND: To identify latent profiles of resilience and fear of progression in patients undergoing lung resection and evaluate their relationships with discharge symptoms and postoperative frailty. METHODS: This two-wa...
BACKGROUND: To identify latent profiles of resilience and fear of progression in patients undergoing lung resection and evaluate their relationships with discharge symptoms and postoperative frailty. METHODS: This two-wave longitudinal observational study enrolled 387 patients undergoing video-assisted thoracic surgery. Preoperative psychological constructs (resilience and fear of progression) were assessed at admission (T1), while postoperative symptoms and frailty status were evaluated at the time of discharge (T2). Latent profile analysis and the robust three-step approach were used to identify unobserved patient subgroups. Multivariable linear and logistic regression analyses were then applied to evaluate the independent associations between these psychological profiles and discharge symptom burden as well as postoperative frailty status, after adjusting for perioperative clinical covariates. RESULTS: Three distinct profiles were identified: "Low Resilience-High Fear Group" (Profile 1, 24.3%), "Balanced Group" (Profile 2, 39.0%), and "High Resilience-Low Fear Group" (Profile 3, 36.7%). Living alone was a significant covariate associated with profile membership (P < 0.05). For discharge symptoms, using Profile 1 as the reference, membership in Profile 2 (b = -4.89) and Profile 3 (b = -16.95) was significantly associated with lower symptom scores (both P < 0.05). Regarding postoperative frailty at discharge, patients in Profile 3 had a 77% lower likelihood of worsening frailty status than those in Profile 1 (OR = 0.23, 95% CI: 0.13-0.40, P < 0.001). Additionally, primary caregiver type, preoperative frailty, and surgical procedures were independently related to discharge frailty status (all P < 0.05). CONCLUSIONS: Preoperative psychological stratification serves as an independent indicator of discharge symptoms and frailty status. These findings confirm that classification based on psychological variables provides critical clinical information not captured by standard surgical indices. Prioritizing psychological risk stratification in thoracic surgical workflows is necessary to guide targeted perioperative interventions and improve recovery outcomes.
A Tale of Two Pathways: Same-Surgeon Versus Different-Surgeon Resection After Second Surgical Opinion.
Mevawalla A, Woldesenbet S, Sarfraz A … +5 more , Alizai Q, Angez M, Elemosho A, Chatzipanagiotou OP, Pawlik TM
J Surg Oncol · 2026 Jun · PMID 42366900 · Publisher ↗
BACKGROUND: The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the sam...
BACKGROUND: The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the same surgeon or with a different surgeon after the SSO. We sought to characterize perioperative outcomes relative to SSO among older adults with GI cancers. METHODS: Using SEER-Medicare data (2000-2019), patients aged 66-90 with primary GI were identified. Cancer-directed resections were categorized into three claims-observed pathways: surgery without SSO, SSO with same-surgeon resection, and SSO with different-surgeon resection. Multivariable regression models assessed the association between operative pathway and perioperative outcomes including complications, extended length of stay (LOS), 90-day readmission and mortality, discharge disposition, and achievement of a composite "textbook outcome." RESULTS: Among 40,603 surgical patients, 56.2% underwent surgery without SSO, 5.3% underwent SSO with same-surgeon resection, and 38.5% underwent SSO with different-surgeon resection. Compared with no SSO, SSO followed by resection with a different surgeon was associated with lower odds of 90-day readmission (aOR 0.92, 95%CI 0.88-0.97), any complications (aOR 0.90, 95%CI 0.84-0.95), extended LOS (aOR 0.93, 95%CI 0.88-0.98), and mortality (aOR 0.67, 95%CI 0.58-0.78), as well as higher discharge-home (aOR 1.05, 95%CI 1.01-1.12) and textbook outcome (aOR 1.12, 95%CI 1.07-1.17). In contrast, SSO with same-surgeon resection was associated with higher complications (aOR 1.14, 95%CI 1.01-1.29), longer LOS (aOR 1.21, 95%CI1.09-1.35), and lower home discharge (aOR 0.77, 95%CI 0.70-0.85) with no survival advantage. CONCLUSION: Among older adults undergoing GI cancer surgery, SSO followed by resection with a different surgeon was associated with improved perioperative safety and recovery, whereas SSO followed by resection with the same surgeon was not associated with similar benefit. These findings suggest that the value of SSO may lie in its role as a pathway to a different surgical team when clinically appropriate.
Plastic surgeon or surgical oncologist: Impact of surgical training background on outcomes in microsurgical head and neck reconstruction.
Jaleefar A, Shirkhoda M, Garajei A … +4 more , Arab Kheradmand A, Zardoui A, Mousavi SZ, Sharifi A
Surg Oncol · 2026 Jun · PMID 42364596 · Publisher ↗
BACKGROUND: Microvascular free flap reconstruction is central to contemporary head and neck cancer surgery. Although plastic surgeons have traditionally performed these reconstructions, evolving training pathways have en...
BACKGROUND: Microvascular free flap reconstruction is central to contemporary head and neck cancer surgery. Although plastic surgeons have traditionally performed these reconstructions, evolving training pathways have enabled other surgical subspecialties to acquire advanced microsurgical expertise. Comparative data between plastic surgeons and surgical oncologists trained in microsurgical reconstruction remain limited. METHODS: We performed a retrospective cohort study of 300 patients who underwent head and neck reconstruction at the Cancer Institute of Iran between 2013 and 2022. Patients were stratified by operating surgeon specialty (surgical oncologist vs. plastic surgeon). Primary outcomes included operative duration, postoperative hemorrhage, flap failure, intensive care unit (ICU) stay, and mortality. Cumulative sum (CUSUM) analysis was used to assess performance trends and learning curves over time. RESULTS: Of 300 reconstructions, 192 (64.0%) were performed by surgical oncologists and 108 (36.0%) by plastic surgeons. Baseline demographics and comorbidities were comparable between groups. There were no significant differences in flap failure (9.4% vs. 9.3%), postoperative hemorrhage (7.3% vs. 3.7%), ICU stay, or mortality (4.2% vs. 3.7%). Operative duration was longer in the surgical oncology group on unadjusted analysis; however, surgeon specialty was not an independent predictor after multivariable adjustment. CUSUM analysis demonstrated stable outcomes over time for both groups, with no evidence of an active learning curve. CONCLUSION: In a high-volume center with structured microsurgical training, surgical oncologists achieve outcomes comparable to plastic surgeons in head and neck reconstruction. These findings support expansion of microsurgical reconstruction beyond traditional specialty boundaries when appropriate training and institutional support are present.
Five-year survival after minimally invasive versus open gastrectomy: A meta-analysis of randomized controlled trials with trial sequential analysis.
Nasri S, Laamiri G, Ben Safta A … +6 more , Trabelsi MM, Kammoun N, Samaali I, Bouasker I, Nouira R, Dziri C
Surg Oncol · 2026 Jun · PMID 42364595 · Publisher ↗
BACKGROUND: Debates persist regarding long-term oncological safety of mini-invasive gastrectomy (MIG)compared to open gastrectomy (OG). KLASS-02 trial and CLASS-01 trial concluded to the absence of statistically signific...
BACKGROUND: Debates persist regarding long-term oncological safety of mini-invasive gastrectomy (MIG)compared to open gastrectomy (OG). KLASS-02 trial and CLASS-01 trial concluded to the absence of statistically significant difference in oncologic outcomes between the two approaches. This meta-analysis evaluates the 5-year survival outcomes of MIG versus OG with Trial Sequential Analysis (TSA). METHODS: A systematic literature search was conducted in Medline, Embase and Scopus. The primary endpoint was 5-year overall survival (OS), and secondary endpoints included stage-specific OS and 5-year disease-free survival (DFS). Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. TSA was performed to estimate the robustness of the meta-analysis. RESULTS: Ten randomized trials were included. No significant difference in 5-year OS was observed between MIG and OG groups (RR = 1.009; 95% CI:0.994-1.025; p = 0.247; tau = 0). Subgroup analysis by TNM stage and meta-regression by percentage of total gastrectomies in the included trials confirmed long-term oncological safety of MIG irrespective of the TNM stage or the extent of the gastric resection. No significant statistical difference was observed for 5-year DFS (RR = 1.007; 95% CI:0.985-1.030; p = 0.514; tau = 0). TSA for 5-year OS demonstrated that the cumulative Z-curve crossed the futility boundaries and exceeded the required information size, confirming no statistical difference between the two approaches. CONCLUSION: MIG offers 5-year overall and disease-free survival outcomes comparable to those of OG.
Ovarian teratoma and the anti-N-methyl-D-aspartate receptor encephalitis paraneoplastic phenomenon: A systematic review and analysis of the literature.
Conway D, Dufour L, Lockley M … +4 more , MacDonald N, Rees J, Murray MJ, Stoneham S
Surg Oncol · 2026 Jun · PMID 42361457 · Publisher ↗
BACKGROUND: Paraneoplastic syndromes occurring with germ-cell-tumors (GCTs) are rare but can be life-threatening. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the commonest GCT-associated paraneoplasti...
BACKGROUND: Paraneoplastic syndromes occurring with germ-cell-tumors (GCTs) are rare but can be life-threatening. Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the commonest GCT-associated paraneoplastic syndrome. We reviewed anti-NMDAR encephalitis associated with ovarian teratomas, aiming to identify key themes regarding presentation and outcomes of treatment. METHODS: A hybrid, thematic-based PRISMA-compliant review was undertaken. Firstly, a systematic review (English; 1998-2023) describing patients <45 y with ovarian teratomas associated with anti-NMDAR encephalitis identified 89 publications, describing 99 patients in sufficient detail. A thematic-based analysis was then undertaken; recovery from encephalitis was defined as: full: patient returning to pre-morbid baseline; partial: ongoing sequalae from disease; none: deterioration, relapse, and/or death. RESULTS: Ninety-six of 99 patients (97.0%) had surgery, of which 90 had recovery data. Of these, 12 (13.3%) had surgery alone and 78 (86.7%) adjuvant treatment [chemotherapy (n = 21), intravenous immunoglobulin (IVIG) ± methylprednisolone (n = 74), both (n = 17)]. Overall, 56/90 (62.2%) had full, 31/90 (34.4%) partial, and 3/90 (3.3%) no recovery. No differences were observed for full (range 53.0-62.2%) or partial (33.3-47.0%) recovery, with no predictors of full recovery by patient age, rapidity of presentation and/or diagnosis, imaging modality, nor use of adjuvant treatment. There was no difference in outcomes for those patients with oophorectomies compared with ovarian-sparing surgery. CONCLUSION: The addition of adjuvant chemotherapy or immunomodulatory treatments to surgery did not improve outcomes. Where possible, ovarian-sparing surgery should be offered. We recommend judicious use of additional treatments beyond surgery, where evidence remains sparse. A proposed diagnostic algorithm will facilitate prompt identification/treatment of anti-NMDAR encephalitis associated with ovarian teratoma.
Central nervous system metastases after gastrectomy for gastric cancer.
Yeo CS, Jeong JY, Hwang J … +4 more , Park SH, Cho M, Kim YM, Hyung WJ
Surg Oncol · 2026 Jun · PMID 42361456 · Publisher ↗
INTRODUCTION: Central nervous system (CNS) metastases from gastric cancer are exceedingly rare, occurring in fewer than 1% of patients, but are associated with poor prognosis. As advances in systemic therapies prolong su...
INTRODUCTION: Central nervous system (CNS) metastases from gastric cancer are exceedingly rare, occurring in fewer than 1% of patients, but are associated with poor prognosis. As advances in systemic therapies prolong survival, the incidence of CNS metastases appears to be increasing. However, robust real-world evidence remains limited. METHODS: We retrospectively reviewed 23,125 patients who underwent gastrectomy for gastric cancer from 1988 to 2019. CNS metastases (brain and/or leptomeningeal) were confirmed radiologically or pathologically. Clinical characteristics, treatments, and survival outcomes were analyzed. Overall survival was estimated using Kaplan-Meier methods, and prognostic factors were assessed using Cox regression models. RESULTS: CNS metastases were identified in 53 patients (0.23%) at a median interval of 14.8 months after gastrectomy. Sites of involvement included brain-only (n = 36, 67.9%), leptomeningeal-only (n = 11, 20.8%), and both (n = 6, 11.3%). The median overall survival following CNS metastases was 2.4 months. In multivariable analysis, leptomeningeal involvement (hazard ratio [HR], 3.47; 95% confidence interval [CI], 1.50-8.04; P = 0.004) and presence of other systemic metastasis (HR, 2.11; 95% CI, 1.03-4.32; P = 0.041) were independent predictors of poor survival. Conversely, both single-modality (HR, 0.35; 95% CI, 0.13-0.89; P = 0.028) and multimodality treatments (HR, 0.35; 95% CI, 0.12-0.99; P = 0.048) significantly improved survival compared with best supportive care. CONCLUSION: CNS metastases from gastric cancer are rare but carry a dismal prognosis. Survival was adversely affected by leptomeningeal involvement and systemic metastatic burden, while active treatment was associated with improved outcomes. Early recognition and multidisciplinary evaluation may identify patients who could benefit from aggressive local or multimodality therapy.
Surgery after neoadjuvant chemotherapy for synchronous and exclusive peritoneal metastasis from colorectal cancer: a descriptive retrospective cohort study.
Dubois J, Martin E, Dumont F … +4 more , De Franco V, Verriele-Beurrier V, Raoul JL, Simmet V
Surg Oncol · 2026 Jun · PMID 42348949 · Publisher ↗
OBJECTIVES: Colorectal cancer (CRC) with synchronous and exclusive peritoneal carcinomatosis (PC) is rare and associated with poor prognosis. The role and type of neoadjuvant chemotherapy (NAC) before cytoreductive surge...
OBJECTIVES: Colorectal cancer (CRC) with synchronous and exclusive peritoneal carcinomatosis (PC) is rare and associated with poor prognosis. The role and type of neoadjuvant chemotherapy (NAC) before cytoreductive surgery (CRS) remains controversial. We aimed to characterize this population and evaluate outcomes and prognostic factors after surgery following NAC. METHODS: We conducted a retrospective study of CRC patients with isolated synchronous PC (2016-2021) who received NAC followed by surgical reassessment. The primary endpoint was overall survival (OS). Prognostic factors included the peritoneal cancer index (PCI) and Peritoneal Regression Grading Score (PRGS). RESULTS: Eighty-one patients were included (median follow-up 80.7 months). NAC regimens were FOLFOX (70%), FOLFIRI (12%), or FOLFIRINOX (17%); 54% also received targeted therapy. CRS was performed in 54 patients (65%), with complete cytoreduction (R0) achieved in 94%. Twenty-seven patients (33%) did not undergo CRS after NAC. 5-year OS was 29.5% and median OS was 37.9 months in the global population. Median OS in patients who had a CRS with HIPEC, a CRS without HIPEC and who did not have a CRS were 54,9 months [37.0-NA], 37,1 months [28.0-48.9] and 20.9 months [16.2-39.9] respectively. Targeted therapy or type of NAC were not associated with improved OS. PRGS showed clinical relevance with a median OS 54.9 months (PRGS 1-2) vs 34.5 months (PRGS 3-4) (HR = 2.23 [0.94-5.25], p = 0.067). In multivariable analysis, PCI by increments of 5 was associated with worse OS (HR = 1.27 [1.03-1.58], p = 0.026) while HIPEC was associated with improved OS (HR = 0.48 [0.24-0.96], p = 0.039). PRGS showed clinical relevance with a median OS 54.9 months (PRGS 1-2) vs 34.5 months (PRGS 3-4) (HR = 2.23 [0.94-5.25], p = 0.067). CONCLUSIONS: In CRC patients with isolated PC, complete CRS is a key survival factor. HIPEC seems to lead to an improvement in overall survival among our patients, and its benefits remain a subject of debate. Further trials are needed to define optimal regimens and personalize strategies.
Prehabilitation for patients undergoing pelvic exenteration.
Saadeh OA, Temperley HC, Mac Curtain BM … +8 more , Cronin P, O'Sullivan NJ, Lonergan PE, Buckley CE, Francis E, McLoughlin L, Creavin B, Kelly ME
Surg Oncol · 2026 Jun · PMID 42348948 · Publisher ↗
BACKGROUND: Pelvic exenteration (PE) is a highly complex surgical procedure associated with significant morbidity and prolonged recovery. Although prehabilitation has been shown to improve perioperative outcomes in color...
BACKGROUND: Pelvic exenteration (PE) is a highly complex surgical procedure associated with significant morbidity and prolonged recovery. Although prehabilitation has been shown to improve perioperative outcomes in colorectal and other major oncologic surgeries, its role in PE remains unclear. This study aims to evaluate the potential application and clinical relevance of prehabilitation for patients undergoing PE. METHODS: A narrative review of the literature was conducted to examine the role of prehabilitation in major oncologic surgery, with a focus on its applicability to pelvic exenteration. Relevant studies were identified through searches of PubMed, Embase, and Google Scholar. Evidence from colorectal and other surgical populations was included when direct PE-specific data were lacking. RESULTS: Prehabilitation programs, typically incorporating exercise, nutritional optimization, and psychological support, have been shown to improve functional capacity, reduce postoperative complications, and shorten hospital stays in colorectal surgery. However, no studies were identified that specifically evaluate prehabilitation in the PE population. Patients undergoing PE often present with significant physiological and psychological burdens, suggesting a potentially greater benefit from prehabilitation. Key challenges include treatment-related toxicity, nutritional deficits, and the complexity of coordinating multimodal interventions within constrained preoperative timelines. CONCLUSIONS: The physiological rationale and supporting data from related surgical populations suggest that prehabilitation would confer meaningful benefits for patients undergoing pelvic exenteration. Prospective studies are needed to assess the "best" type of exercise and rehabilitation programs prior to PE.
Prognostic stratification in resected pulmonary neuroendocrine carcinomas: Analysis of the French database EPITHOR.
Fournel L, Huriet M, Charrier T … +10 more , Boulate D, Falcoz PE, Brouchet L, Baste JM, Pagès PB, Glorion M, Etienne H, Setlinger J, Prieto M, Dahan M
Surg Oncol · 2026 Jun · PMID 42341696 · Publisher ↗
OBJECTIVE: Pulmonary neuroendocrine carcinomas, encompassing large-cell (LCNEC) and small-cell lung carcinoma (SCLC), are aggressive tumors in which surgical resection is indicated with caution. Aim of the study was to p...
OBJECTIVE: Pulmonary neuroendocrine carcinomas, encompassing large-cell (LCNEC) and small-cell lung carcinoma (SCLC), are aggressive tumors in which surgical resection is indicated with caution. Aim of the study was to perform a large survival analysis, identify prognostic factors and refine patient stratification using a data-driven clustering approach. METHODS: We extracted all patients from the exhaustive EPITHOR national database who underwent resection of pulmonary neuroendocrine carcinomas between 2002 and 2023. Log-Rank tests and conventional Cox-regressions were performed to assess impact of variables on survival, including cluster label based on non-categorical preoperative characteristics computed by the K-means method. RESULTS: 1936 neuroendocrine carcinomas were identified, 1229 LCNEC (63.5%) and 707 SCLC (36.5%). Mean age at surgery was 63.8 years, with 68.8% men. Anatomic pulmonary resection was performed in 97.1% of cases, and 90-days morbidity-mortality rates were 33.8% and 8.3%, respectively. Five-year OS reached 52.9% for LCNEC and 45.5% for SCLC. Three different clusters were calculated, in which distribution of pTNM stages and histological type were not significantly different. Log-Rank analyses revealed that tobacco consumption, sex, TNM stage, histological type, and cluster label were statistically associated with OS. The prognostic impact of cluster remained significant across most subgroups, including sex and pTNM stage. Cox analyses confirmed sex, pTNM, histological type, and cluster as independent predictors, with clustering showing stronger prognostic value than histological type. CONCLUSION: s: Resection of pulmonary neuroendocrine carcinomas yields encouraging outcomes in highly selected patients. Further TNM-stage and histology, prognostic stratification could be improved by a clustering approach based on simple preoperative characteristics.
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